OBJECTIVES: To present a cost-effectiveness analysis of nivolumab monotherapy versus commonly prescribed third-line (3L) treatment in small cell lung cancer (SCLC).

METHODS: A partitioned survival model with 3 health states (progression-free [PF], progressed disease [PD], and death) was developed from a US payer perspective. A systematic literature review identified no randomised controlled or single-arm trials that reported outcomes separately for 3L SCLC patients for any treatment. As topotecan was frequently prescribed in real-world clinical practice (SEER and Flatiron electronic health database) for 3L SCLC patients, it was chosen as the comparator. Clinical inputs for topotecan were derived from Flatiron data (January 2011 to September 2017) with inclusion/exclusion criteria matched to 3L+ nivolumab-treated patients in CheckMate 032 (January 2018 database lock). Clinical efficacy of IV and oral topotecan were assumed equivalent. The base-case analysis used a 20-year lifetime horizon. Patients entered the model in the PF health state. Cost-effectiveness of treatments were calculated by combining estimated time spent in the PF and PD states with the costs and health utilities assigned to those states based on parametric survival curves. An annual discount rate of 3% for costs and outcomes was applied.

RESULTS: Incremental cost per quality adjusted life-year (QALY) gained with nivolumab was US$153,312 versus IV topotecan and US$123,003 versus oral topotecan. When results were disaggregated, nivolumab-related costs were mainly driven by drug acquisition cost and topotecan-related costs were primarily due to treatment of adverse events. Deterministic sensitivity analysis showed that changes in discount rate for costs, outcomes, and body weight had the greatest impact on the results.

CONCLUSIONS: Based on the literature on willingness-to-pay for a QALY in metastatic cancer, nivolumab monotherapy represents a cost-effective option for 3L+ treatment of SCLC compared with IV and oral topotecan.